Maimonides Evening of Research
Fellow Winner
Gene Sobol, MPH
Department of Surgery
Procedural Safety Process Project – Improving compliance with the Time out and Sign Out (debrief) Elements of the 3-part Procedural Safety Process
Objective
Given the robust evidentiary support for improved safety in procedural outcomes by compliance with a uniform procedural safety process (PSP), we set out to assess our current compliance and improve compliance with both “time out” and “sign out (debrief)” elements of the three-part procedural safety process.
Methods
Utilizing the “Arrowsight” video/audio monitoring system in the Gellman 4 operating suite, we followed the percentage of time outs (TO) and sign outs (SO – also known as debriefs) that were compliant with standard policy beginning 7.1.2023 with the intention to continue until 7.1.2024. “Compliance” required that; (1) TO or SO happens, (2) all items of the relevant checklist be addressed, (3) the required time threshold be met, and (4) no distractions occur during the TO or SO. Failure on any of these four parameters was considered to be “noncompliant.” Between June/2023 and September 4, 2023 we established the baseline for compliance. We then provided robust education (at intervals) about the requirements for appropriate conduct of these elements. We followed percent compliance for both TO and SO on a daily basis and are reporting the findings to date as below.
Results
The starting point for compliance for TO was ~ 50% and for SO as 8%. The majority of the infractions for TO were either “abbreviated TO” or “missing items” (7%). Regarding the SO the overwhelming majority of infractions were “no SO done.” (72%) Over the first four months of the project we have seen an improvement in compliance. Currently, our TO compliance is ~ 85% and SO compliance ~ 40%.
Conclusion
While we had expected poor compliance with the SO (debrief) element of the PSP, we had not expected the almost uniform lack of compliance. Perhaps more surprisingly, we had anticipated almost uniform compliance with the TO element and found only 50% compliance. Our interventions, repeated education and weekly sharing of data, have led to significant improvements but the improvement has been slow and variable.